| NPI | 1912565284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: PA MD484821) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OK 390200000X) |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2024-06-14 |